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ptosis repair

Kathy Posted Tue 08th of March, 2011 15:16:36 PM

What is the correct modifier to use when billing a ptosis repair bilaterally. '67904' Cathy

Nikhil Answered Tue 08th of March, 2011 15:46:37 PM

I know that you are expecting a direct answer of this question.

But, I would suggest if you submit the details of your query, reason being that I have witnessed very high frequency of denials for cpt 67904. Please let me know if you want the info for the reason that you have faced denials or you are asking this just for coding info that you are billing for the first time.

Mark Answered Tue 08th of March, 2011 16:38:44 PM

Kathy,

It all depends upon the insurance company submission rules for bilateral procedures. Most will require 'RT' & 'LT'.
Another reason for denials of this code is medical necessity, although sometimes that is not clear from the EOB or reply that comes from the Insurance Comp. My suggestion if you are being denied and the reason isn' completely clear, call the insurer and ask for the specific reason it is being denied. If it is med nec., then you'll need to get with the physician and send the documentation the insurer requires to cover the procedure.

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